For non-neuroscientists, the spinal cord is often considered simply as a relay between the brain and peripheral organs such as the skin, smooth muscles, and skeletal muscles. However, its gray matter has also been shown to play a pivotal role in the control of stereotyped motor behaviors. Neuroscientists have indeed clearly shown recently that the spinal cord contains command centers also known as central pattern generators. Those spinal centers have been found to elicit, inhibit or modulate locomotion, ejaculation, defecation and micturition. This short communication briefly outlines the main characteristics of the central pattern generator for micturition and how it could become a therapeutic target for innovative drugs against micturition-related problems.

How to cite this article:
Guertin PA. A central pattern generator in the spinal cord for the central control of micturition: An opportunity for first-in-class drug treatments.Asia Pac J Clin Trials Nerv Syst Dis 2019;4:1-2

Micturition depends essentially, for the storage and periodic elimination of urine, on the coordinated activity of smooth and striated muscles of the lower urinary tract system: the urinary bladder, the bladder neck, the urethra and the urethral sphincters. The bladder and urethral sphincters are controlled in a reciprocal and thus coordinated manner to accomplish both urine storage and micturition (also known as voiding or urination). During storage, urine is retained in the bladder in response to sympathetic activation, producing bladder relaxation via adrenergic signaling through the hypogastric nerve, and activation of the somatic pudendal nerve output from the Onuf's nucleus producing a coordinated contraction of the external urethral sphincter. During voiding, the parasympathetic system (preganglionic neurons in S2–4) is activated rhythmically, producing cyclic contraction of the detrusor muscle of the bladder via cholinergic excitation through the pelvic nerve, whereas the urethral sphincters (internal and external elements) are relaxed concomitantly, allowing urine to leave the bladder and flow through the urethra. The control of urination depends therefore upon autonomic, spinal and supraspinal mechanisms. This indicates compelling evidence exists of a central pattern generator (CPG) for micturition –the spinal micturition center –that is localized in the sacral spinal cord. Indeed, experiments have shown that automatic or reflex-like well-coordinated voiding in low-thoracic spinal cord-transected cats as well as in humans (paraplegics) could be induced by intraspinal stimulation at the upper sacral level (Nashold et al., 1971; Friedman et al., 1972).

A key role for sacral S1 has been proposed by Pikov et al. (2007), using intraspinal electrodes, that S2 stimulation produces bladder contractions insufficient for full voiding behavior, whereas stimulation of sacral S1 generates powerful coordinated bladder contractions and external urethral sphincter relaxation leading to voiding of the bladder. Epidural stimulation at low frequency (1 Hz) between L2 and S1 was also shown recently in low-thoracic spinal cord-tansected rats to elicit both locomotion and micturition suggesting interconnections between the two CPGs (Gad et al., 2014). Those findings provide strong evidence that some important elements of a CPG for micturition are localized mainly in sacral segments of the spinal cord. This is also supported by anatomical, electrophysiological and pharmacological data. In rats, spinal interneurons retrogradely-labeled by injection of pseudorabies virus into the urinary bladder were identified in sacral segments receiving afferent input from the bladder (Nadelhaft and Vera, 1995; Sugaya et al., 1997). A comparable distribution was reported by Vizzard et al. (1995) following injections of virus into the urethra or the external urethral sphincter, suggesting also the existence of a CPG for micturition in the sacral segments. In addition, spinal interneurons nearby the dorsal commissure, superficial dorsal horn and sacral parasympathic nucleus receiving afferent input from the lower urinary tract express c-Fos following noxious or non-noxious stimulation of the bladder and urethra in rats (Birder and de Groat, 1993; Birder et al., 1999). Some of them send projections to the brain, whereas others make local connections in the spinal cord.

The Copyright License Agreement has been signed by the author before publication.

Plagiarism check

Checked twice by iThenticate.

Peer review

Externally peer reviewed.

Open access statement

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.